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Self-esteem, emotional distress and sexual behavior among adolescent females: Inter-relationships and temporal effects.

Journal of Adolescent Health 2006; 38:268-274.

Ethier KA, Kershaw TS, Lewis JB, Milan A, Niccolai LM, Ickovics JR.

Abstract
PURPOSE: The current analyses attempt to clarify the relationship between psychological factors and sexual behavior. We test a model examining relationships between sexual history (e.g., age at initiation, partner history) and self-esteem and emotional distress (e.g., depression, anxiety, stress, hostility) and their impact on future sexual risk behavior (e.g., unprotected sex, multiple sexual partners). METHODS: The current analyses included 155 sexually active adolescent females, aged 14-19 years, who participated in the first two waves of a longitudinal study of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) and pregnancy risk. The Rosenberg Self-esteem scale, the Perceived Stress Scale, and three subscales of the Brief Symptom Inventory (depression, anxiety, hostility) and a variety of self-report measures of sexual history and sexual behavior were administered. Structural equation modeling using LISREL 8.51 was used to assess the proposed model. RESULTS: Our model exhibited adequate fit and demonstrated that sexual history reported retrospectively at baseline was related to self-esteem and emotional distress also measured at baseline. These variables predicted sexual risk behavior measured 6 months later. Adolescents who had lower self-esteem at baseline reported initiating sex earlier and having had risky partners. Alternatively, adolescents with more emotional distress at baseline were less likely to have had a previous STD, had more partners per year of sexual activity and a history of risky partners. Self-esteem influenced subsequent unprotected sex and emotional distress influenced subsequent multiple partners. CONCLUSIONS: This model suggests that self-esteem and emotional distress have contrasting relationships with sexual behavior and demonstrates the importance of the temporal nature of these variables. Implications for intervention are discussed.